INFECTIOUS DISEASEAdults don’t get botulism from
eating honey because the
presence of normal intestinal
flora prevents colonization of
the GI tract.In cases of clear-cut botulism,
withhold antibiotics until
antitoxin administered.SYMPTOMS/EXAM
■ Food-borne
■ Direct toxin ingestion (eg, canned foods)
■ Incubation: ~1 day (range: 6 h–10 days)
■ Descending weakness
■ Cranial nerve palsies (eg, diplopia, dysphagia, dysarthria)
■ Followed by descending paralysis and respiratory failure
■ Wound
■ From open wounds and IVDA (eg, “black tar” heroin)
■ Incubation period ~1 week
■ Lower mortality than food-borne
■ Infantile (usually <1 year old)
■ Ingestion of spores (typically in honey)
■ Constipation followed by
■ Poor feeding (fever absent)
■ Weak cry
■ Decreased muscle tone/loss of head control
■ Depressed deep tendon reflexes
■ Respiratory failure (50%)
DIFFERENTIAL
Gastroenteritis, myasthenia gravis, Guillain-Barré, Bell palsy, tick paralysis,
poliomyelitis, diphtheria, Eaton-Lambert, anticholinergic or organophosphate
toxicity
DIAGNOSIS
Clinical (EMG may be useful)
TREATMENT
■ Supportive care
■ Respiratory (early intubation)
■ Decontamination
■ Bowel irrigation in food-borne and infant types
■ Wound irrigation in wound type
■ Botulinum antitoxin
■ Trivalent antibodies to toxin Types A, B, and E (derived from horse serum)
■ Neutralizes only circulating toxin
■ Not recommended in infant type due to low efficacy and risk of anaphylaxis
■ Human botulism immunoglobulin available for infants
■ Avoid antibiotics!
■ May increase cell lysis and promote toxin release.
■ In wound type may use for concomitant infection after antitoxin given
COMPLICATIONS
■ Respiratory failure
■ Mortality 50% (without ICU) to 8% (with ICU)
A 30-year-old otherwise healthy male gardener presents with ulcerating le-
sions progressing up his arm 3 weeks after planting a new rose bush.
What is the diagnosis and treatment?
Sporotrichosis and itraconazole.